Enhanced Recovery After Surgery (ERAS) Cystectomy. Patient Diary

Transcription

1 Enhanced Recovery After Surgery (ERAS) Cystectomy Patient Diary

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3 Introduction Enhanced Recovery is a new way of improving the experience and well-being of people who need major surgery. It will help you to recover sooner so that life can return to normal as quickly as possible. The programme focuses on making sure that you are actively involved in your recovery. There are four main stages: planning and preparation before admission (including early nutrition). reducing the physical stress of the operation. a structured approach to peri-operative (during surgery) and postoperative (after surgery) management, including pain relief. early mobilisation (getting you moving as soon as possible). The purpose of this diary is for you to record your thoughts and feelings and to note down your progress during your time in hospital after your operation. We encourage relatives and friends to be involved in your recovery; they can help you recover by taking you for walks, provided the nurses agree it is safe to do so. The diary is designed for you to complete; however, relatives, friends and members of the team looking after you (doctors, nurses and nursing assistants) can help you to fill it in if you find this difficult. This diary sets out an example of what to expect in the first few days after your surgery. The programme may not be suitable for everyone. If this is the case for you, the team looking after you can make changes; making sure that the care you receive is not only of the highest quality, but is also designed around your specific needs. This document is not legally binding and if your recovery is different to the programme set out, this is nothing to be worried about. We realise that every person is different and everyone will achieve the goals at their own pace. Whilst we hope that you will complete this diary, it will not affect your care if you choose not to. page 3

4 Day of Surgery These are the aims: The doctors and nurses will stabilise your condition on the Churchill Overnight Recovery Unit after surgery. You will be helped to sit up in bed. Mobility: (tick if achieved) I was able to sit up in bed Nutrition: (tick if achieved) I was able to have some water to drink Urostomy pouch/stoma: (tick if achieved) I was shown my urostomy pouch I was shown my urostomy pouch supplies How do you feel today? page 4

5 Post-operative Day One These are the aims: Transferred to the Urology Ward to continue with your recovery. You will be helped to sit in the chair and go for walks with assistance. Mobility: (tick if achieved) I was able to sit in the chair for 1-2 hours (am and pm) I was able to go for two walks Distance walked... (aim for 2 x 100 metres) Chewing gum: I was able to chew sugar-free gum for 20 minutes at: 10am 3pm 8pm Nutrition: (tick if achieved) Aim to drink about 1 litre in total (a hospital jug full) I was able to have something to drink Water Squash Tea/Coffee I was able to drink my nutritional supplement am pm Urostomy pouch/stoma: (tick if achieved) I was shown my urostomy pouch I was shown my urostomy pouch supplies How do you feel today? page 5

6 Post-operative Day Two These are the aims for today: Sit in the chair, go for walks with assistance, have something to eat and drink. Mobility: (tick if achieved) I was able to sit in the chair for 1-2 hours (am and pm) I was able to go for two walks Distance walked... (aim for 2 x 100 meters) Chewing gum: I was able to chew sugar-free gum for 20 minutes at: 10am 3pm 8pm Nutrition: (tick if achieved) I was able to have something to drink Water Squash Tea/Coffee I was able to drink my nutritional supplement drinks am pm I was able to have soup and light puddings to eat (e.g. yoghurt, mousse, custard, jelly, creme caramel, ice-cream, stewed fruit, rice pudding) Urostomy pouch/stoma: (tick if achieved) I was shown how to disconnect and reconnect to my night bag I was shown how to empty my urostomy pouch I was shown how to change my urostomy pouch How do you feel today? page 6

7 Post-operative Day Three These are the aims for today: Sit in the chair for meals, go for walks with assistance, have something to eat and drink. Mobility: (tick if achieved) I was able to sit in the chair for 1-2 hours at meal times I was able to go for four walks Distance walked... (aim for 3-4 x 150 meters) Chewing gum: I was able to chew sugar-free gum for 20 minutes at: 10am 3pm 8pm Nutrition: (tick if achieved) I was able to have something to drink Water Squash Tea/Coffee I was able to drink my nutritional supplement drinks am I was able to have something light to eat (e.g. cornflakes, Rice Krispies, white bread or toast, egg, chicken, mashed potato, fish, rice, cheese, pasta) Urostomy pouch/stoma: (tick if achieved) I was shown how to disconnect and reconnect my night bag I was shown how to empty my urostomy pouch I was able to empty my urostomy pouch on my own I was shown how to change my urostomy pouch I was able to change my urostomy pouch on my own How do you feel today? pm page 7

8 Post-operative Day Four These are the aims for today: Sit in the chair for meals, go for several walks (ask for help if you need it), have something to eat and drink. Mobility: (tick if achieved) I was able to sit in the chair for 1-2 hours at meal times I was able to go for four walks Distance walked... (aim for 3-4 x 150 meters) I was able to walk to the toilet on my own I managed to have a wash in the bathroom Nutrition: (tick if achieved) I was able to have something to drink Water Squash Tea/Coffee I was able to eat more than half of my light meals I was able to drink my nutritional supplement drinks am pm Urostomy pouch/stoma: (tick if achieved) I was shown how to disconnect and reconnect my night bag I was shown how to empty my urostomy pouch I was able to empty my urostomy pouch on my own I was shown how to change my urostomy pouch I was able to change my urostomy pouch on my own How do you feel today? page 8

9 Recovery goals and targets Below is a list of goals and targets we would like you to achieve to help your recovery and to get ready for leaving hospital. We realise that every person is different and everyone will achieve the goals at their own pace; this is for you to make a note of the day you reached the goal for your own reference and to let you see your progress. Goal/Target Sit out of bed for more than six hours a day, returning to bed for one to two hour rest in the afternoon Walk the length of the ward and back Get dressed into your own clothes (unaided) Managing your meals Managing your nutritional supplement drinks Care for your urostomy pouch/stoma under supervision from the ward staff Care for your urostomy pouch/stoma independently without supervision Be assessed as competent to safely administer your dalteparin injections, if applicable (or have an alternative option in place if unable to self-administer) Post-operative day achieved page 9

10 Care of urostomy pouch/stoma The table below is for you to record the care of your urostomy pouch/ stoma. You will need to be able to look after your urostomy pouch/ stoma on your own before you leave hospital. Please use the table below to record the day that you reached each goal. This is for your reference only and allows you to see your progress. Goal/Target I was able to disconnect and reconnect my night bag I was able to empty my urostomy pouch under supervision I was able to empty my urostomy pouch on my own I was able to change my urostomy pouch under supervision I was able to change my urostomy pouch on my own I have all the equipment ready for going home I know how to contact my stoma nurse page 10 Post-operative day achieved Your stoma nurse will call you after you have been discharged from hospital and may arrange to visit you at home. If you live outside Oxfordshire, you will be referred to your local stoma team. The stoma nurse will organise all of your stoma supplies shortly after you have been discharged.

11 Leaving hospital The Enhanced Recovery Programme is based on criteria-led discharge and when you have achieved all the criteria, it is time for you to leave hospital. The criteria are listed below (please tick when achieved this is for your reference only) Discharge criteria Assessed as medically fit for discharge Effective pain control with oral analgesics (painkillers) Eating and drinking with no nausea or vomiting Independently mobile; able to get yourself out of bed and on/off toilet Independent with urostomy pouch/stoma care Bowels opened Competent with dalteparin self-administration (if applicable), or have an alternative option in place Tick when achieved page 11

12 NOTES

13 NOTES

14 Enhanced Recovery Team My Consultant is... My Urology Specialist Nurse is... My Dietitian is... If you have a specific requirement, need an interpreter, a document in Easy Read, another language, large print, Braille or audio version, please call or PALSJR@ouh.nhs.uk Author: Elaine Tustian and Hamira Ghafoor, Enhanced Recovery Programme Facilitators April 2017 Review: April 2020 Oxford University Hospitals NHS Foundation Trust Oxford OX3 9DU OMI 13879P

15 Your experience (1) We would like to understand how you felt about your recent stay in hospital and would be grateful if you would answer the following questions. Your answers will be treated confidentially. We value your input in helping us look at ways of improving our service. Thank you Were you involved as much as you wanted to be in decisions about your care and treatment? (please tick one answer) Yes, definitely Yes, to some extent No How much information about your condition or treatment was given to you? (please tick one answer) Not enough Too much The right amount Did you feel you were involved in decisions about your discharge from hospital? (please tick one answer) Yes, definitely No Yes, to some extent I did not need to be involved Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? (please tick one answer) Yes Don t Know/Can t remember No What did we do well? (please comment) What could we improve? (please comment)

16 Your experience (2) Did you find the Enhanced Recovery After Surgery patient information leaflet useful? Yes No Did this make you feel please circle the most appropriate word(s) Well informed prepared in control confident happy supported unclear unprepared out of control anxious stressed unsupported frustrated Did you find the Enhanced Recovery After Surgery patient diary useful? Yes No Did this make you feel please circle the most appropriate word(s) Well informed prepared in control confident happy supported Unclear unprepared out of control anxious stressed unsupported frustrated Did your overall care experience make you feel please circle the most appropriate word(s) Well informed prepared in control confident happy supported Unclear unprepared out of control anxious stressed unsupported frustrated Do you have any other comments? After completion, tear this page out of the booklet and leave on the hospital ward before you are discharged home. Thank you CYSTECTOMY